If you have Addison’s disease, you will need to take daily medication to replace the lost hormones. This should ensure that you can continue to lead a normal life.
Treating the underlying cause
In some cases, the underlying causes of Addison’s disease can be treated. For example, tuberculosis (TB) is treated with a course of antituberculous medication over a period of at least six months.
Other infections may be treated with antibiotics or antifungal medication, as necessary. Autoimmune conditions will be treated, although they cannot usually be cured.
Treating Addison’s disease
In the majority of cases of Addison’s disease, treatment will involve corticosteroid (steroid) replacement therapy, which is ongoing for life. Corticosteroid medication is used to replace the cortisol and aldosterone that your body no longer produces. This is usually taken in tablet form (orally) once or twice a day.
Synthetic glucocorticoids such as hydrocortisone are used to replace the cortisol. Other possible medicines are prednisolone or dexamethasone, though these are less commonly prescribed.
Aldosterone is replaced with oral doses of a mineralocorticoid, called fludrocortisone. Your GP may also ask you to add extra salt to your daily diet, although if you are taking enough fludrocortisone medicine this might not be necessary. Unlike most people, if you feel the urge to eat something salty, then you should eat it.
Living with Addison’s disease
Addison’s disease should not affect your quality of life or how long you live. Your diet, exercise and daily routine can all continue as normal.
You will usually need to have appointments with an endocrinologist every 6-12 months, although your GP can provide support and repeat prescriptions in between these visits. As long as you take your medication, the symptoms of Addison’s disease should completely disappear.
However, failing to take your medication could cause an adrenal crisis. Therefore, you must:
- remember to collect your repeat prescriptions
- keep spare medication as necessary - for example, in the car or at work and always carry some spare medication with you
- take your medication every day at the right time of day
- pack extra medication if you are going away - usually, double what you would normally need and your injection kit (see below, under emergency treatment) just in case you become ill
- carry your medication in your hand luggage, if you are travelling by plane, with a note from your doctor explaining why it is necessary
You could also inform close friends or colleagues of your condition, and warn them about the risks of adrenal crisis.
Medical alert bracelets
It is also a good idea to wear a medical alert bracelet or necklace that informs people that you have Addison’s disease.
After a serious accident, such as a car crash, your body should produce cortisol. This helps you to cope with the stressful situation and the additional strain on your body that results from serious injury. As your body cannot produce cortisol, you will need a hydrocortisone injection to replace it and prevent an adrenal crisis.
If you are wearing a medical alert bracelet it will inform any medical staff that may need to treat you about your condition, and what medication you require.
Medical alert bracelets or necklaces are pieces of jewellery that are engraved with your medical condition, in this case Addison’s disease, as well as an emergency contact number. They are available from a number of retailers. Ask your GP if there is one that they recommend, or go to the MedicAlert website.
If you need to stay in hospital, the healthcare professionals who are responsible for your care will also need to know that you need steroid replacement medication throughout your treatment.
Adjusting your medication
At certain times, your medication may need to be adjusted to take into account any additional strain on your body. For example, you may need to increase the dosage of your medication if you experience any of the following:
- an illness or infection - particularly if you have a high temperature of 37.5C (99.5F)
- an accident
- you need to have an operation, dental or medical procedure (e.g. tooth filling, endoscopy)
- you are taking part in strenuous exercise which is not usually part of your daily life
This will help your body to cope with the additional stress. Your GP will monitor your dosage and advise you about any changes. Over time, as you get used to the condition and learn what can trigger your symptoms, you may learn how to adjust your medication yourself. However, always consult your GP if you are unsure.
Emergency treatment
You and a partner or family member may be trained to administer an injection of hydrocortisone in an emergency. This could be necessary if you go into shock after an injury, or if you experience vomiting or diarrhoea and are unable to keep down oral medication. This may occur if you are pregnant and have morning sickness.
Your endocrinologist will discuss with you when an injection might be necessary. You will be given needles, syringes and hydrocortisone, and training in how to use them.
If you need to administer emergency hydrocortisone, always call your GP immediately afterwards. Check what out-of-hours services are available from your primary care trust in case the emergency is outside normal working hours.
You can also register yourself with your local ambulance service, so they have a record of your requirement for a steroid injection or tablets, if you need their assistance.
Treating adrenal crisis
Adrenal crisis, or Addisonian crisis, needs urgent medical attention. Dial 999 to request an ambulance if you or someone you know are experiencing adrenal crisis.
You will be given lots of fluid through a vein in your arm to rehydrate you. This will contain a mixture of salts and sugars (sodium, glucose and dextrose) to replace those that your body is lacking. You will also be injected with hydrocortisone to replace the missing hormone, cortisol.
Any underlying causes of the adrenal crisis, such as an infection, will also be treated.
